Effect of diaphragm manual release versus conventional breathing exercises and prone positioning on physical functional performance in women with COVID-19: A randomized trial

INTRODUCTION: Manual therapy has recently gained much interest in managing COVID-19 patients. This study aimed to mainly compare the effect of diaphragm manual release to the effect of conventional breathing exercises and prone positioning on physical functional performance in women with COVID-19. METHODS: Forty COVID-19 women patients completed this study. They were randomly assigned to two groups. Group A received diaphragm manual release, and group B received conventional breathing exercises and prone positioning. Both groups received pharmacological treatment. Inclusion criteria were moderate COVID-19 illness, women patients, and ages from 35 to 45 years. The outcome measures were 6-min walk distance (6MWD), chest expansion, Barthel index (BI), oxygen saturation, fatigue Assessment Scale (FAS), and Medical Research Council (MRC) dyspnea scale. RESULTS: Both groups showed significant improvements in all outcome measures compared to the baseline (p < 0.001). Compared to group B, group A showed more significant improvements in the 6MWD (MD, 22.75 m; 95% CI, 15.21 to 30.29; p < 0.001), chest expansion (MD, 0.80 cm; 95% CI, 0.46 to 1.14; p < 0.001), BI (MD, 9.50; 95% CI, 5.69 to 13.31; p < 0.001), the O(2) saturation (MD, 1.3%; 95% CI, 0.71 to 1.89; p < 0.001), the FAS (MD, −4.70; 95% CI, −6.69 to −2.71; p < 0.001), and dyspnea severity assessed by the MRC dyspnea scale (p = 0.013) post-intervention. CONCLUSION: Combined with pharmacological treatment, diaphragm manual release could be superior to conventional breathing exercises and prone positioning in improving physical functional performance, chest expansion, daily living activities, O(2) saturation, and measures of fatigue and dyspnea in middle-aged women with moderate COVID-19 illness. TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR), retrospective, PACTR202302877569441.